Designing Clinical Space for the Delivery of Integrated Behavioral Health and Primary Care
Open accessAbstract
PURPOSE: This study sought to describe features of the physical space in which practices integrating primary care and behavioral health care work and to identify the arrangements that enable integration of care. METHODS: We conducted an observational study of 19 diverse practices located across the United States. Practice-level data included field notes from 2-4-day site visits, transcripts from semistructured interviews with clinicians and clinical staff, online implementation diary posts, and facility photographs. A multidisciplinary team used a 4-stage, systematic approach to analyze data and identify how physical layout enabled the work of integrated care teams. RESULTS: Two dominant spatial layouts emerged across practices: type-1 layouts were characterized by having primary care clinicians (PCCs) and behavioral health clinicians (BHCs) located in separate work areas, and type-2 layouts had BHCs and PCCs sharing work space. We describe these layouts and the influence they have on situational awareness, interprofessional "bumpability," and opportunities for on-the-fly communication. We observed BHCs and PCCs engaging in more face-to-face methods for coordinating integrated care for patients in type 2 layouts (41.5% of observed encounters vs 11.7%; P < .05). We show that practices needed to strike a balance between professional proximity and private work areas to accomplish job tasks. Private workspace was needed for focused work, to see patients, and for consults between clinicians and clinical staff. We describe the ways practices modified and built new space and provide 2 recommended layouts for practices integrating care based on study findings. CONCLUSION: Physical layout and positioning of professionals' workspace is an important consideration in practices implementing integrated care. Clinicians, researchers, and health-care administrators are encouraged to consider the role of professional proximity and private working space when creating new facilities or redesigning existing space to foster delivery of integrated behavioral health and primary care.
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- Authors
- Gunn, R., Davis, M. M., Hall, J., Heintzman, J., Muench, J., Smeds, B., Miller, B. F., Miller, W. L., Gilchrist, E., Brown Levey, S., Brown, J., Wise Romero, P., & Cohen, D. J.
- Affiliations
- Oregon Health & Science University (US)
- Venue
- The Journal of the American Board of Family Medicine
- Published
- 2015-09-01
- Volume
- 28
- Issue
- Supplement 1
- Pages
- S52-S62
- ISSN
- 1557-2625 (ISSN-L)
- 1558-7118
- PMC
- PMC7304942
- OpenAlex
- W2177234527
- Cited by
- 70
- References
- 22
- Citations by year
- 2026: 5 · 2025: 2 · 2024: 3 · 2023: 7 · 2022: 6 · 2021: 4 · 2020: 8 · 2019: 9 · 2018: 12 · 2017: 6 · 2016: 1 · 2015: 7
- FWCI
- 14.22
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The Journal of the American Board of Family Medicine (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Colorado Health Foundation (CHF-3848)
- Maine Health Access Foundation (2012FI-0009)
- Agency for Healthcare Research and Quality (K12HS022981, K12 HS022981 01, PCOR K12, 1k12hs022981-01)
- U.S. Public Health Service (8846.01-S01)
- Topics
- Social Sciences › Psychology › Social Psychology › Facilities and Workplace Management
- Social Sciences › Urban Studies › Healthcare Facilities Design and Sustainability
- Social Sciences › Business, Management and Accounting › Organizational Behavior and Human Resource Management › Healthcare Systems and Technology
- Keywords
- behavioral health integration, primary care, physical layout, situational awareness, provider communication, care coordination, practice redesign, healthcare facility design
- MeSH terms
- Mental Disorders, Community Mental Health Services, Facility Design and Construction, Humans, Practice Management, Medical, Primary Health Care, United States, Delivery of Health Care, Integrated
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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